NPI | 1104463819 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: GA APRN-NP292038) |
Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: GA RN292038) |
Enumeration Date | 2019-12-02 |
Last Update Date | 2025-10-13 |